Exposure with response prevention versus habit reversal in Tourettes's syndrome: a controlled study

The intentional nature of tics provides the opportunity to apply behavioural interventions aimed at tic reduction through interruption of stimulus-response sequences. The aim of this study has been to evaluate the effect of exposure and response prevention (ER) versus habit reversal (HR) in 43 Tourette's syndrome (TS) patients. The three outcome measures were: the Yale Global Tic Severity Scale (YGTSS), 15-min tic frequency registrations monitored at the institute and 15-min home tic frequency registrations. Both treatment conditions resulted in statistically significant improvements on all outcome measures (p < 0.001). No significant differences were found between the treatment conditions on any of the outcome measures, although there was a tendency in favour of ER on the YGTSS (p = 0.05). These results suggest that, at least in the short term, TS tic symptoms can be treated effectively with both types of treatment.     

Changes in values cognition after rating values-associated feelings

This study investigated values change as an outcome of assessing feelings elicited by contemplating the actualization of the same values. The subjects were divided into an experimental and a control group. They completed three tests in a single session. In the pretest, all subjects were asked to rate the importance of 20 values items on a 4-point scale. Subjects in the experimental group were then asked to rate the degree of pleasure they would feel in actualizing each of the values, while those in the control group rated the degree of inequality they considered women suffer in the actualization of each of the values. The post-test consisted of the same items as the pretest. The subjects in the experimental group completed a second post-test 3 months later. It was found that the experimental procedure produced significant change in the ratings of 15 values at the post-test, whereas the control procedure produced change in only five. The results suggest that rating one's emotional response to a value-related situation can change one's cognition of that value. At the post-test 3 months later, only 3-value ratings remained changed.     

Review of studies evaluating psychotherapy in bulimia nervosa: the influence of research methods

The purpose of the study was to test if design and research methods of studies predict outcome results of bulimia nervosa. Fifty-seven articles on outcome of bulimia nervosa were found through MEDLINE and PSYCHINFO databases and 25 were included in the statistical analysis. Percentages of patients with a good outcome ranged from 24% to 74% with a mean of 51.1%. The variables best predicting outcome were time to follow-up and number of symptoms evaluated in definition of good outcome whereas dropout, design of studies, treatments, and sample characteristics did not predict significantly. The implications of these findings are discussed.     

Active-imaginal exposure: examination of a new behavioral treatment for cynophobia (dog phobia)

The aims of this study were to investigate exposure-based treatments for cynophobia (dog phobia) and to test a newly developed hybrid imaginal exposure treatment that we have named active imaginal exposure. The treatment introduces an in vivo coping component to imaginal exposure whereby the patient physically performs coping responses to an imagined feared stimulus. Eighty-two participants meeting DSM-IV criteria for specific phobia (animal subtype) were randomly assigned to one of three 30-min. treatments: (a) active-imaginal exposure (AI), (b) imaginal exposure alone (IE), or (c) graduated in vivo exposure (IV). Participants completed a behavioral approach test at pre, post, and four-week follow-up. Significant pre- to posttreatment improvement was observed in all three treatment conditions. Response rates at posttreatment were 51.9, 62.1, and 73.1% for the IE, AI, and IV groups respectively. Likewise, effect sizes at posttreatment were 0.76, 1.41, and 1.55 for the IE, AI, and IV groups respectively. Although in the predicted direction, the between group differences were not significant. A similar pattern of results was observed at follow-up. Further, safety behavior utilization during treatment was associated with less improvement--particularly in the two imaginal treatment conditions. Exposure treatments of dog phobia appear feasible and effective in reducing phobic fear and avoidance associated with dog phobia. Furthermore, preliminary evidence suggests that our active-imaginal exposure treatment may be a viable alternative to in vivo exposure.     

An outcome management program for extending advances in choice research into choice opportunities for supported workers with severe multiple disabilities

We evaluated an outcome management program for increasing choice opportunities provided by 2 job coaches for 5 supported workers with severe multiple disabilities in a community job. The program involved specifying and monitoring behavioral outcomes among workers and staff, training staff, and supportive and corrective feedback. Increased choice provision occurred for both job coaches across a 1-year period. Results indicate how outcome management can help translate advances in choice research into routine practice.     

Emancipatory responses to oppression: the template of land-use planning and the Old Order Amish of Ontario

In this paper I discuss the clash of values between the Old Order Amish community of Ontario and the dominant social paradigm in agriculture. Land-use and agricultural regulations, designed for an industrial style of agriculture, are experienced as a threat to the survival of the Old Order Amish agricultural social economy and community. The paper describes how I have worked with the Old Order Amish to respond to these challenges and to create public policies that will allow them to maintain their human and agricultural diversity and small-scale sustainable farm practices. Four case studies illuminating the oppressive land-use regulations along with the emancipatory responses to the oppression are examined. The social transformation themes include principles and processes for community psychologists, land-use planners, and community economic development practitioners to consider. The article has heuristic value for a practice-based approach to social change.     

European values in bioethics: why,what, and how to be used?

Are there distinctly European values in bioethics, and if there are, what are they? Some Continental philosophers have argued that the principles of dignity, precaution, and solidarity reflect the European ethos better than the liberal concepts of autonomy, harm, and justice. These principles, so the argument goes, elevate prudence over hedonism, communality over individualism, and moral sense over pragmatism. Contrary to what their proponents often believe, however, dignity, precaution, and solidarity can be interpreted in many ways, and it is not clear which reading would, or should, be favored by popular opinion. It is therefore dangerous to think that any one understanding of "European", or any other, values could be legitimately imposed on those who have different ideas about morality in health care and related fields. Bioethical principles should be employed to promote discussion, not to suppress it.     

Getting scientists to think about what they are doing

Research scientists are trained to produce specialised bricks of knowledge, but not to look at the whole building. Increasing public concern about the social role of science is forcing science students to think about what they are actually learning to do. What sort of knowledge will they be producing, and how will it be used? Science education now requires serious consideration of these philosophical and ethical questions. But the many different forms of knowledge produced by modern science cannot be covered by any single philosophical principle. Sociology and cognitive psychology are also needed to understand what the sciences have in common and the significance of what they generate. Again, traditional modes of ethical analysis cannot deal adequately with the values, norms and interests activated by present-day technoscience without reference to its sociological, political and economic dimensions. What science education now requires is ‘metascience’, a discipline that extends beyond conventional philosophy and ethics to include the social and humanistic aspects of the scientific enterprise. For example, students need to learn about the practices, institutions, career choices, and societal responsibilities of research scientists, and to rehearse in advance some of the moral dilemmas that they are likely to meet. They need also to realise that science is changing rapidly, not only in its research techniques and organisational structures but also in its relationships with society at large.     

Recapturing the Person in the Therapist: An Exploration Of Personal Values, Commitments, and Beliefs

The authors encourage an approach to personal exploration that attempts to recapture the person in the therapist. Person in the therapist training is aimed at helping therapists discover or re-capture their own values, beliefs, and personal ethics. A personal approach to theory development and the practice of therapy is offered and discussed. Activities to recapture the person in the therapist focus on developing a personal theoretical orientation, exploring the values of family therapy theories, and exploring the values of the stance of the therapist in the therapy session. The authors offer their own personal beliefs throughout the article and encourage further development of these issues.Co-director of The Re-Authoring Center and a PhD student in Marriage and Family Therapy at Iowa State UniversityCo-director of The Re-Authoring Center and a PhD student in Marriage and Family Therapy at Iowa State University     

The Role of Schools in Outcomes for Youth: Implications for Children's Mental Health Services Research

We explore the role of schools in children's mental health services research. Recent literature has suggested that schools play an important role in delivering services to children and adolescents with emotional and behavioral problems. Research in services research, though, has taken a fairly narrow view of which dimensions of school environments are relevant for inclusion in studies. We suggest that a broader view of school environments is appropriate and potentially beneficial to the field. Using Bronfenbrenner's ecological model as a guide, we conceptualize schools as microsystems. Such an approach suggests that all aspects of school environments (treatment as well as non-treatment) are likely to influence many of the outcomes that children's mental health services research frequently targets (e.g., behavioral problems, problematic peer relationships, academic achievement, school attendance). We review literature from a variety of disciplines to suggest relevant features of schools, with particular attention to the role of peer dynamics within schools. We conclude with implications of this expanded conceptualization of schools for children's mental health services research.